Open enrollment is bullshit that, as someone who has access to healthcare through work, is my nearly constant hassle with insurance outside of getting insurance to actually pay for anything outside of preventative medicine. I don’t think that’s a unique take or some kind of revelation - being forced into a few week long window to be forced to choose a single plan for your family is pretty easy when you work for a large company that basically gives 1-2 options anyways and employs people to help with the process, but working for a small company trying to have insurance benefits that compete with large companies offers more variety and a labyrinth of options. Many times it’s made worse by using a third party HR company, which as you might imagine make money by not being helpful.
And what’s worse is that as far as I can tell, the reason for open enrollment is to make accounting easier, despite a typo potentially leaving you without insurance for a full year - which has now officially happened to my family twice. At least this time it’s just dental insurance and not health insurance like years ago.
Anyway, I’m still furious after getting off the phone with my third party HR firm again about this and I was hoping maybe someone could explain how open enrollment is a good system or just complain along with me.
As I get older, I find that I am asked to choose between a plan I can’t really afford and that might not give me enough coverage and one that I can barely afford that which does not provide enough coverage.
Just got a letter from Aetna saying they may or may not keep covering an expensive medication I have.
They unhelpfully suggest alternative drugs that I’ve been on before and spent considerable effort and time weaning myself off of due to their extremely addictive nature.
I’m fed up with insurance.
Why do voters keep supporting republicans who’s policy is: If you get sick, then it’s somehow your fault and I don’t care if you or your kids die. Gotta keep human suffering profitable for the insurance companies.
In specific regards to health plans it is normally called Annual Enrollment (H&W AE) and there are specific reasons around the administration of the plan that requires it to be done during a specific window.
Realize it takes months of work leading up to that enrollment window to prep communications and materials as needed. Plus it then is weeks potentially months of operational efforts after that to set up all the final selections (effort being relative to number of participants and options).
The average window is two weeks for most H&W plans, some plan sponsors will offer more or less based on changes to offerings and such. Truth be told, many participants just continue with whatever coverage they previously had.
It can be frustrating to be certain if you have a host of options to dive through; however, a good rule of thumb is always: if you have frequent health costs a primary HMO probably makes the most sense. If you are relatively healthy and need only preventative services, a high deductible plan with an HSA or FSA probably would work best for you. Of course mileage varies and it is absolutely a very high level rule of thumb.
I find it hard to believe a typo would leave you without insurance until the next window. Most record keepers are open to correcting an issue from the enrollment window; though it is why there are multiple warnings stating to check the information carefully to ensure accuracy. Additionally, many windows even upon closing have a grace period of a week or two to correct found issues prior to the new year and coverage beginning. Some plans allow for wholesale changes to coverage based on certain life events such as death, marriage, divorce, birth, etc.
You are not alone in being frustrated with an imperfect system however…at all.
I have never heard anyone call it annual enrollment in my life. There is an open enrollment period when anyone can apply, and outside that window it takes a qualifying event. It’s an anti-competition crapfest in both cases.
I’m aware of what it is, I just know it’s complete bunk. The stated reasons it exists is to align health insurance contracts to ensure that you can’t pick up and bail from insurance and thus ruin the actual pot of money being used to pay for health coverage, but at best that’s an excuse since you can just have people sign up for a contract for a set period of time like basically every other system in existence. As a (poor) example, cell phone companies lose money on hardware sales in order to make money on the contracts because the cost is for a fixed period of time.
[quote=“quorihunter, post:4, topic:102894”]
I find it hard to believe a typo would leave you without insurance until the next window. Most record keepers are open to correcting an issue from the enrollment window; though it is why there are multiple warnings stating to check the information carefully to ensure accuracy. Additionally, many windows even upon closing have a grace period of a week or two to correct found issues prior to the new year and coverage beginning. Some plans allow for wholesale changes to coverage based on certain life events such as death, marriage, divorce, birth, etc.
[/quote]OK, so let’s break this down for a second using my most recent example.
I apply for family dental coverage
Person submitting it to Metlife clicks the wrong box
Having been signed up for individual dental coverage, the enrollment window closes
After the grace period I receive my card
And now I get to hear about how it’s my fault my coverage is wrong when I submitted all the proper paperwork and someone else screwed the pooch, and that absolutely nothing can be done until the next enrollment period. It’s fun to be on the phone for hours to be told this days later from some supervisor that half-read the case. I love that this isn’t even the first time this has happened, and last time it left me without health insurance.
If I hear “oh, well you should have received a confirmation email/letter that confirmed your coverage. Since you didn’t reply with changes you agreed to the terms of the insurance” again…
Like I said, I get why its frustrating…and yes this is why you should recheck and recheck again all those confirmations. I feel like it is also a case of poor customer service; because there should be a way to fix that. I know my employer as a record keeper of H&W does in fact do for us as participants.
Its not bunk, there are guidelines as to why there are windows for annual enrollment, and restrictions on time frames even for open enrollment around life events.
I wish the process with your provider was better and more flexible.
Disagree strongly. It is bunk. Every time you change jobs, or your employer changes HR companies, or the company changes insurance companies, or the insurance company changes what plans are available, your entire family has months of uncertainty. Uncertainty about whether they’ll be able to get the health care that they need, whether they’ll have to switch doctors (again), whether there will even be a doctor available in the new plan’s ‘network’, whether the new plan will pay for their medication or force them to switch to something less effective. And one mistake made anywhere by any one of the middlemen involved (employer, HR company, insurance company, network, health administration company) means that you spend a year without the health care that you need (and that a doctor doesn’t get business that they need).
Why? The only apparent reason to the consumer is so that some administrators somewhere can shuffle papers around to feel important and some executives can raise prices again so that they can buy a new mercedes. It doesn’t help consumers or medical professionals in any apparent way and only causes problems.
Below is just rant.
My latest experience: my daughter was told by her doctor that the insurance company had refused to pay for her last appointment because the birthdate on record didn’t match. She called the insurance company and they put that one claim through but said that any future claims for the rest of the year would be rejected unless the HR company fixed their records as well, and that any previous claims this year had probably also been rejected so there might be bills on the way. Went to fix it at the HR company but their website was closed for 3 days. (Yes, their website was closed because it was after business hours on a Friday!) It appears to be fixed now (although no one has confirmed that yet) but any bills will have to be bounced back to the medics to resubmit to insurance. None of that is helpful to us, the doctors, the insurance company, or the HR company. It’s just nonsense that does no good for anyone involved.
Before that, on a different plan, it was finding out (after open enrollment closed) that there was only one doctor (of a particular type) in the entire state that accepted that plan’s insurance and my daughter was stuck with that doctor (who was overloaded and rarely had appointments available) for a year no matter what. Of course, they hadn’t included that important bit of info in the open enrollment brochure.
I used to run benefits enrollment for a small (<500 FTE) company. It was always a cluster fuck. Online enrollment (rather than paper) helped improve things a little. I would sit with employees (& spouses!) & help with filling out forms. I would hand & email confirmations to everyone. I would “extend” open enrollment by two weeks (really just starting two weeks early so that we could catch errors). If somehow an error occurred or a change needed to be made, I lied my ass off/argued until I got the insurance companies to make sure employees got the coverage they needed. A good HR person should do that - unfortunately, the field is filled with craven bureaucrats who like punishing people for checking the wrong box. As bad as payroll clerks. Glad I’m out of that game.
Based on what you’ve stated here. This is what i tried to relay above. There are regulations and plan requirements as to why there time frames in place to an enrollment window (whether due to life events or annual enrollment). If the above statements from folks are true wherein a single mistake left them without insurance it is a bad process and service that lead to it.
I’ve been doing this for 16 years. Online and automated processes helps tremendously vs manual forms and documentation. I’ve never seen a case of one mistake meant zero coverage as we as a record keeper have always had processes to ensure we correct those issues.
Point is. It isn’t bunk. It isn’t made up just to screw someone over. It’s unfortunate that the bad experiences mentioned above are due to poor quality and lack of care in the workplace at those companies as far as I can tell.
Except you (just like many others) are just saying the regulations are in place for a “reason.” Those reasons are absolutely against the interests of the people that need health coverage. And no other system of contractual obligation works in this bizarre system that absolutely gets fouled up regularly - even if it is through human error (which a well designed system can account for, and this one specifically does not).
I don’t really care that you have a lot of experience working on the system, I’ve had the same level of experience being forced to use it.
I hope you leave lots of room for the limitations on your personal experience. 16 years is a long time, subjectively speaking.
I don’t like it when I see what appears to be handwaving in response to someone who is upset and in the middle of a thing, and you’re a little close to that here, in my opinion.
Realize it takes months of work leading up to that enrollment window to prep communications and materials as needed.
Just like every other area of human endeavor? We can only start it in small windows and there are hard expiration dates, just like in nature, right? If you don’t set out for California by May 1, you can’t go until next year. If you don’t go for a swim in the summer, all pools are closed to you in winter. That’s just how life works!! Hard lines are a required part of health care. They are, from what you seem to say, inevitable and for the best. But maybe they aren’t? I don;t see the logic to it? Why is it on me to make my companies life easier? It won’t have a heart attack and die if it has to do the paperwork a different way. I could (not likely, but I have a heart). Please excuse the sarcasm, and I don’t mean to rant at you personally but likely have, but who is being helped with arbitrary lines again?
See, there isn’t really a good reason for limiting when people can change their coverage - it’s all baloney. Holdover from when smaller insurance companies needed to maintain a certain pool size of “insurables” in order to make the business cost effective. When insurance premiums and profits were regulated. That’s all gone & the cost is passed directly on to the consumer. Now it’s just greed that keeps those requirements in place.
You think that’s bad… I’ve been told by an employer more than once that I need to choose and sign for a new plan (because the company is changing providers, or just that the available plans are changing) a few days before the deadline. That is bullshit. It’s usually an “oh, sorry, this slipped,” excuse, but when it happens more than once you have to wonder if it’s to prevent employees from having the time needed to shop around for competing plans.
